{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T20:03:38Z","timestamp":1781726618663,"version":"3.54.5"},"reference-count":43,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2020,3,19]],"date-time":"2020-03-19T00:00:00Z","timestamp":1584576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Spanish Government","award":["DPI2016-78831-C2-2-R"],"award-info":[{"award-number":["DPI2016-78831-C2-2-R"]}]},{"name":"National Council of Technological and Scientific Development, CNPq \u2013 Brazil","award":["202050\/2015-7"],"award-info":[{"award-number":["202050\/2015-7"]}]},{"name":"National Council of Technological and Scientific Development, CNPq \u2013 Brazil","award":["207688\/2014-1"],"award-info":[{"award-number":["207688\/2014-1"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>(1) Background: nocturnal hypoglycemia (NH) is one of the most challenging side effects of multiple doses of insulin (MDI) therapy in type 1 diabetes (T1D). This work aimed to investigate the feasibility of a machine-learning-based prediction model to anticipate NH in T1D patients on MDI. (2) Methods: ten T1D adults were studied during 12 weeks. Information regarding T1D management, continuous glucose monitoring (CGM), and from a physical activity tracker were obtained under free-living conditions at home. Supervised machine-learning algorithms were applied to the data, and prediction models were created to forecast the occurrence of NH. Individualized prediction models were generated using multilayer perceptron (MLP) and a support vector machine (SVM). (3) Results: population outcomes indicated that more than 70% of the NH may be avoided with the proposed methodology. The predictions performed by the SVM achieved the best population outcomes, with a sensitivity and specificity of 78.75% and 82.15%, respectively. (4) Conclusions: our study supports the feasibility of using ML techniques to address the prediction of nocturnal hypoglycemia in the daily life of patients with T1D on MDI, using CGM and a physical activity tracker.<\/jats:p>","DOI":"10.3390\/s20061705","type":"journal-article","created":{"date-parts":[[2020,3,19]],"date-time":"2020-03-19T03:54:14Z","timestamp":1584590054000},"page":"1705","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":78,"title":["Prediction of Nocturnal Hypoglycemia in Adults with Type 1 Diabetes under Multiple Daily Injections Using Continuous Glucose Monitoring and Physical Activity Monitor"],"prefix":"10.3390","volume":"20","author":[{"given":"Arthur","family":"Bertachi","sequence":"first","affiliation":[{"name":"Institute of Informatics and Applications, University of Girona, 17003 Girona, Spain"},{"name":"Federal University of Technology\u2014Paran\u00e1 (UTFPR), Guarapuava 85053-525, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6888-0396","authenticated-orcid":false,"given":"Clara","family":"Vi\u00f1als","sequence":"additional","affiliation":[{"name":"Diabetes Unit, Endocrinology and Nutrition Dpt. Hospital Cl\u00ednic de Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3356-8375","authenticated-orcid":false,"given":"Lyvia","family":"Biagi","sequence":"additional","affiliation":[{"name":"Institute of Informatics and Applications, University of Girona, 17003 Girona, Spain"},{"name":"Federal University of Technology\u2014Paran\u00e1 (UTFPR), Guarapuava 85053-525, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Contreras","sequence":"additional","affiliation":[{"name":"Institute of Informatics and Applications, University of Girona, 17003 Girona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6884-9789","authenticated-orcid":false,"given":"Josep","family":"Veh\u00ed","sequence":"additional","affiliation":[{"name":"Institute of Informatics and Applications, University of Girona, 17003 Girona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Diabetes y Enfermedades Metab\u00f3licas Asociadas (CIBERDEM), 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Conget","sequence":"additional","affiliation":[{"name":"Diabetes Unit, Endocrinology and Nutrition Dpt. 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Rev. Endocrinol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/S2213-8587(18)30315-2","article-title":"Hypoglycaemia, cardiovascular disease, and mortality in diabetes: Epidemiology, pathogenesis, and management","volume":"7","author":"Amiel","year":"2019","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1186\/1477-7525-11-90","article-title":"Health-related quality of life associated with daytime and nocturnal hypoglycaemic events: A time trade-off survey in five countries","volume":"11","author":"Evans","year":"2013","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1002\/dmrr.796","article-title":"How hypoglycaemia can affect the life of a person with diabetes","volume":"24","author":"Frier","year":"2008","journal-title":"Diabetes-Metab. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1056\/NEJM199309303291401","article-title":"The Diabetes Control and Complications Trial Research Group. The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus","volume":"329","author":"Shamoon","year":"1993","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1056\/NEJM199309163291203","article-title":"Reversibility of Unawareness of Hypoglycemia in Patients with Insulinomas","volume":"329","author":"Mitrakou","year":"1993","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.diabres.2017.08.012","article-title":"The risks of nocturnal hypoglycaemia in insulin-treated diabetes","volume":"133","author":"Graveling","year":"2017","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.diabet.2007.03.007","article-title":"Nocturnal hypoglycaemias in type 1 diabetic patients: What can we learn with continuous glucose monitoring?","volume":"33","author":"Guillod","year":"2007","journal-title":"Diabetes Metab."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group (2009). Effectiveness of Continuous Glucose Monitoring in a Clinical Care Environment: Evidence from the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring (JDRF-CGM) trial. Diabetes Care, 33, 17\u201322.","DOI":"10.2337\/dc09-1502"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1093\/qjmed\/hcp082","article-title":"Nocturnal hypoglycaemia in type 1 diabetes\u2013frequency and predictive factors","volume":"102","author":"Woodward","year":"2009","journal-title":"QJM"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/S0022-3476(97)70197-5","article-title":"Incidence and predictive criteria of nocturnal hypoglycemia in young children with insulin-dependent diabetes mellitus","volume":"130","author":"Porter","year":"1997","journal-title":"J. Pediatr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.2337\/diacare.24.11.1888","article-title":"The Effect of Evening Alcohol Consumption on Next-Morning Glucose Control in Type 1 Diabetes","volume":"24","author":"Turner","year":"2001","journal-title":"Diabetes Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1089\/dia.2014.0342","article-title":"Factors Associated with Nocturnal Hypoglycemia in At-Risk Adolescents and Young Adults with Type 1 Diabetes","volume":"17","author":"Wilson","year":"2015","journal-title":"Diabetes Technol. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1111\/j.1464-5491.2008.02486.x","article-title":"Severe hypoglycaemia and glycaemic control in Type1 diabetes: Meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion","volume":"25","author":"Pickup","year":"2008","journal-title":"Diabet. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2254","DOI":"10.1016\/S0140-6736(16)31535-5","article-title":"Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: A multicentre, non-masked, randomised controlled trial","volume":"388","author":"Bolinder","year":"2016","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1001\/jama.2016.19976","article-title":"Continuous Glucose Monitoring vs Conventional Therapy for Glycemic Control in Adults with Type 1 Diabetes Treated with Multiple Daily Insulin Injections","volume":"317","author":"Lind","year":"2017","journal-title":"JAMA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1089\/dia.2018.0199","article-title":"Impact of Sensor-Augmented Pump Therapy with Predictive Low-Glucose Suspend Function on Glycemic Control and Patient Satisfaction in Adults and Children with Type 1 Diabetes","volume":"20","year":"2018","journal-title":"Diabetes Technol. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2023","DOI":"10.2337\/dc10-2411","article-title":"Insulin Pump Therapy with Automated Insulin Suspension in Response to Hypoglycemia: Figure 1","volume":"34","author":"Choudhary","year":"2011","journal-title":"Diabetes Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3155","DOI":"10.1007\/s00125-012-2708-9","article-title":"The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: A randomised controlled trial","volume":"55","author":"Battelino","year":"2012","journal-title":"Diabetologia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e10775","DOI":"10.2196\/10775","article-title":"Artificial Intelligence for Diabetes Management and Decision Support: Literature Review","volume":"20","author":"Contreras","year":"2018","journal-title":"J. Med. Internet Res."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Contreras, I., Oviedo, S., Vettoretti, M., Visentin, R., and Veh\u00ed, J. (2017). Personalized blood glucose prediction: A hybrid approach using grammatical evolution and physiological models. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0187754"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Georga, E.I., Protopappas, V.C., Polyzos, D., and Fotiadis, D.I. (September, January 28). A predictive model of subcutaneous glucose concentration in type 1 diabetes based on Random Forests. Proceedings of the 2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, San Diego, CA, USA.","DOI":"10.1109\/EMBC.2012.6346567"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1109\/TBME.2012.2188893","article-title":"Neural Network Incorporating Meal Information Improves Accuracy of Short-Time Prediction of Glucose Concentration","volume":"59","author":"Zecchin","year":"2012","journal-title":"IEEE. Trans. Biomed. Eng."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Bunescu, R., Struble, N., Marling, C., Shubrook, J., and Schwartz, F. (2013, January 4\u20137). Blood Glucose Level Prediction Using Physiological Models and Support Vector Regression. Proceedings of the 2013 12th International Conference on Machine Learning and Applications, Miami, FL, USA.","DOI":"10.1109\/ICMLA.2013.30"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e2833","DOI":"10.1002\/cnm.2833","article-title":"A review of personalized blood glucose prediction strategies for T1DM patients","volume":"33","author":"Oviedo","year":"2016","journal-title":"Int. J. Numer. Meth. Biomed."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1177\/1932296818823792","article-title":"Prediction of Hypoglycemia during Aerobic Exercise in Adults with Type 1 Diabetes","volume":"13","author":"Reddy","year":"2019","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijmedinf.2019.03.008","article-title":"Risk-based postprandial hypoglycemia forecasting using supervised learning","volume":"126","author":"Oviedo","year":"2019","journal-title":"Int. J. Med. Inform."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.cmpb.2016.07.003","article-title":"Prediction of nocturnal hypoglycemia by an aggregation of previously known prediction approaches: Proof of concept for clinical application","volume":"134","author":"Tkachenko","year":"2016","journal-title":"Comput. Methods Programs Biomed."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1177\/1932296816672689","article-title":"Sensor-Augmented Insulin Pumps and Hypoglycemia Prevention in Type 1 Diabetes","volume":"11","author":"Steineck","year":"2017","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1089\/dia.2019.0119","article-title":"A Review of Predictive Low Glucose Suspend and Its Effectiveness in Preventing Nocturnal Hypoglycemia","volume":"21","author":"Chen","year":"2019","journal-title":"Diabetes Technol. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1109\/TBME.2004.839639","article-title":"Insulin Kinetics in Type-1 Diabetes: Continuous and Bolus Delivery of Rapid Acting Insulin","volume":"52","author":"Wilinska","year":"2005","journal-title":"IEEE. Trans. Biomed. Eng."},{"key":"ref_32","unstructured":"Beneyto, A., Bertachi, A., Bondia, J., and Vehi, J. (2018). A New Blood Glucose Control Scheme for Unannounced Exercise in Type 1 Diabetic Subjects. IEEE Trans. Control. Netw. Syst., 1\u20138."},{"key":"ref_33","unstructured":"Ozaslan, B., Patek, S., and Breton, M. (2017, January 15\u201318). Quantifying the Effect of Antecedent Physical Activity on Prandial Glucose Control In Type 1 Diabetes: Defining Exercise on Board. Proceedings of the Abstracts from ATTD 2017 10th International Conference on Advanced Technologies & Treatments for Diabetes, Paris, France."},{"key":"ref_34","unstructured":"Haykin, S. (2009). Neural Networks and Learning Machines, Prentice Hall."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Vapnik, V.N. (1995). The Nature of Statistical Learning Theory, Springer.","DOI":"10.1007\/978-1-4757-2440-0"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.aca.2012.11.007","article-title":"Sample size planning for classification models","volume":"760","author":"Beleites","year":"2013","journal-title":"Anal. Chim. Acta"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"9","DOI":"10.2337\/diacare.26.1.9","article-title":"Impact of Bedtime Snack Composition on Prevention of Nocturnal Hypoglycemia in Adults with Type 1 Diabetes Undergoing Intensive Insulin Management Using Lispro Insulin before Meals: A randomized, placebo-controlled, crossover trial","volume":"26","author":"Kalergis","year":"2003","journal-title":"Diabetes Care"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e95","DOI":"10.2337\/dc16-0411","article-title":"Nocturnal Hypoglycemia and Physical Activity in Children with Diabetes: New Insights by Continuous Glucose Monitoring and Accelerometry","volume":"39","author":"Bachmann","year":"2016","journal-title":"Diabetes Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.2337\/dc13-1973","article-title":"Effects of Moderate-to-Vigorous Intensity Physical Activity on Overnight and Next-Day Hypoglycemia in Active Adolescents with Type 1 Diabetes","volume":"37","author":"Metcalf","year":"2014","journal-title":"Diabetes Care"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1089\/dia.2019.0048","article-title":"Predicting Nocturnal Hypoglycemia with Measures of Physical Activity Intensity in Adolescent Athletes with Type 1 Diabetes","volume":"21","author":"Jaggers","year":"2019","journal-title":"Diabetes Technol. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1177\/1932296816670400","article-title":"Glycemic Control Indices and Their Aggregation in the Prediction of Nocturnal Hypoglycemia from Intermittent Blood Glucose Measurements","volume":"10","author":"Sampath","year":"2016","journal-title":"J. Diabetes Sci. Technol."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Kaewkannate, K., and Kim, S. (2016). A comparison of wearable fitness devices. BMC Public Health, 16.","DOI":"10.1186\/s12889-016-3059-0"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Jensen, M.H., Dethlefsen, C., Vestergaard, P., and Hejlesen, O. (2019). Prediction of Nocturnal Hypoglycemia from Continuous Glucose Monitoring Data in People with Type 1 Diabetes: A Proof-of-Concept Study. J. Diabetes Sci. Technol., 250\u2013256.","DOI":"10.1177\/1932296819868727"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/20\/6\/1705\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:07:53Z","timestamp":1760173673000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/20\/6\/1705"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,19]]},"references-count":43,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,3]]}},"alternative-id":["s20061705"],"URL":"https:\/\/doi.org\/10.3390\/s20061705","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,19]]}}}